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Uterine Transplant Basics

Science has made remarkable discoveries in the medical field like we never could have imagined. Today, an alternative is available for women with uterine factor infertility; it’s called a uterine transplant, which consists of taking a healthy uterus from a donor and transplanting it into a patient in need of a uterus. This procedure will make it possible for many women to experience a normal pregnancy.

“Uterus transplantation consists of a complex treatment that combines principles of solid organ transplantation and assisted reproduction techniques. Furthermore, conducted with the aim of promoting fertility and thus improve the quality of life of the patient, and not necessarily to extend it, this is the first ephemeral transplantation, i.e., the transplanted organ may be removed after the treatment’s objectives are achieved.”1

Uterine factor infertility is usually caused by:

  • Being born without a uterus
  • Incorrect functioning of the uterus
  • Having the uterus removed due to medical reasons.

All these circumstances cause the impossibility of conceiving a child naturally.

“Today, transplantation of organs/tissues is not only restricted to transplantation of organs that are necessary for continued life. In recent years, quality-of-life-enhancing types of transplantation, such as of the face, hand and larynx, have also entered the clinical arena. It may well be that uterus transplantation (UTx) will become the first category of quality-of-life-enhancing allogeneic transplantation that is also a life-propagating transplantation. In addition, UTx would be the first type of organ transplantation that can be categorized as ephemeral, with the organ only needed for a restricted time. Thus, life-long immunosuppression, with its associated long-term side effects, would be avoided.”2

“Uterine transplant has been ethically controversial from the start. An initial reaction was that womb transplant is technological overkill, a costly elective procedure so that women might have the experience of pregnancy and delivering their own child when less costly and intrusive options are available. Uterine transplant, however, is likely to be sought only when other options are not feasible. Without transplantation, a woman without a uterus has no alternative to have genetic offspring but a gestational carrier. Surrogacy, however, is totally prohibited in some countries or practically unavailable because of a ban on payment. Nor is surrogacy tourism an easily available option for many women. Even if paid surrogacy is legally available as it is in the USA and within a couple’s means, many women may have religious, cultural, or personal moral reasons for not employing another woman to gestate for them. For them, too, uterine transplant may be the only way to have their own genetically related child.

Uterus transplant is a difficult road and will not be an easy choice even if it is shown to be safe and effective. Transplant will involve long surgery for live donors and recipients, daily immunosuppression, potential in utero effects on offspring, psychological and emotional complexities for donors and recipients, and a great deal of expense. Women will have to be carefully screened, be in a supportive relationship, and have a clear understanding of the risks and benefits. For example, uterus transplant may enable them to carry and birth their own child, but because no nerves are reattached, recipients will not feel movement of the fetus during the pregnancy.”3

Who Donates the Uterus?

Uterine donors and recipients have to be healthy and have certain genetic standards. They should not have had previous major abdominal surgeries, cancers or large myomas, infections, HPV infections, neoplasms (multiplication or abnormal growth of cells in a body tissue), or obesity. The donor must be free from pulmonary or cardiac pathologies that could compromise pregnancy in the new organism. Also, the functionality of the uterus must have been tested.

“When procuring a uterus from a live donor, it is possible to set the time for transplantation to a convenient date and the recipient can receive the transplant at a time when both parties are in an optimized and thoroughly prepared condition, thus increasing the odds of graft survival. This possibility to schedule the surgery also gives ample time to evaluate the donor and the organ prior to the transplantation. Exclusion of unsuitable donor candidates and organs of inferior quality is crucial to the outcome. The presence of systemic illness, donor infertility or subfertility, cervical or endometrial dysplasia, human papillomavirus infection, myomas, adenomyosis, polyps, vascular anatomy, and intrauterine adhesions should be thoroughly evaluated and considered before the procedure is carried out.”4

“A live uterus donor is exposed to the risk of surgical complications during retrieval. This involves an intraoperative laceration of the ureteral wall or a postoperative ureterovaginal fistula. Duration of surgery (mean of 12 hours) poses an increased anesthesia risk. The most time-consuming part of the procedure is the dissection of uterine vessels, mainly the veins. It has been suggested that a larger vein diameter, like the ones of the ovarian veins, would be preferable to use for anastomosis. However, this would require removal of the ovary itself, resulting in potential hormonal dysfunction in a premenopausal woman. The upper part of the uterine vessels (the vessels connecting the uterine vessels to the ovarian vessels) may provide an adequate substitute for anastomosis.”5

How is A Uterine Transplant Surgery Done?

“Uterine transplantation is peculiar due to the fact that the uterus is not a life-sustaining organ (such as heart, liver or kidney), but it is just an “instrumental organ” with the only function to give back to an unfertile woman the ability to become pregnant. In general terms, if an organ transplant should be considered ethically acceptable when it is enables the patient to go on living (heart transplant is emblematic in this regard), those transplants that are not life-saving, but merely aimed at restoring lost organ functions, are much more controversial in ethical nature, especially when they entail significant risk or have a relatively low possibility of success. An example is that of hand transplants. It is well documented that several patients who underwent such surgery have later demanded to have the transplanted hand removed, not because of histocompatibility, but due to psychological issues arising from the perception of the transplanted hand as something not belonging to one’s own body.”6

It involves two surgeries and one in-vitro fertilization procedure. In the transplant operation, the uterus is removed from the donor along with a small portion of the vagina and connected to the recipient. About 40 specialists take part in this operation while taking turns. Patients with a transplanted uterus are required to take meds to avoid rejection of the organ. Fortunately, these medications are safe.

There are many factors in common between a uterine transplant and other types. But, there is one unique detail about uterine transplants, which is that they are just temporary. A hysterectomy will be performed to remove the uterus after 1 or 2 pregnancies.

First, the eggs are harvested and fertilized through regular in vitro fertilization. The embryo from this procedure will be relocated to the transplanted uterus once the organ is safe and healthy inside the new mother. Due to the risks of natural birth, doctors schedule a cesarean delivery.

“Uterus transplantation is still an experimental procedure and should stay at this phase until enough scientific data has accumulated to ensure that UTx is a reasonable safe and effective procedure. An international registry to follow donors, recipients and children born has been formed as part of the activities of the International Society of Uterus Transplantation (ISUTx). Data from that registry will be important to monitor the safety of the procedure, concerning long-term effects of the participants and children born after UTx. Several clinical trials of UTx are now launched in North-America, Europe and Asia. Based on the favourable outcome so far from the first UTx trial, it is predicted that UTx will be in clinical routine at several centers worldwide within 5 years.”7

“Uterus transplantation should be performed by a team comprising transplant surgeons, gynecologists, plastic surgeons, transplant internists, infection specialists, and transplant psychiatrists. Any team planning to perform human uterus transplantations in the future should undergo extensive training and methodological development with the use of large animal models or cadavers. In addition, all aspects of transplantation, including immunosuppression protocols and the follow-up of transplant patients and pregnancies, are fundamental parts of the training process, because the procedure carries major surgical risks to the live donor and recipient, and no definitive conclusions can be made regarding uterus transplantation. Regenerative medicine also holds significant promise for transplantation in the future. Concerning the surgery and immunosuppression-related risks, congenital anatomical variations in the genitourinary system of the recipient, such as solitary pelvic kidney, gestational surrogacy policies should be established in parallel with clinical and experimental uterus transplantation studies.”8

A uterine transplant is the final hope for a woman who was born without a uterus or who has lost it due to some medical issue. Talk about it with your partner and make sure this is a mutual decision filled with hope and a new beginning. It does involve the same risks (known and unknown) as other transplant surgeries (immunosuppression, for example) for the donor, recipient, and newborn. Ask your gynecologist if a uterine transplant could be an option for you.

References:

(1) Silva, A. F. G., & Carvalho, L. F. P. (2016). A meta-analysis on uterine transplantation: Redefining the limits of reproductive surgery. Available online at:

http://observatorio.fm.usp.br/bitstream/handle/OPI/16926/art_SILVA_A_metaanalysis_on_uterine_transplantation_Redefining_the_limits_2016.PDF?sequence=1&isAllowed=y

(2) Johannesson, L., Dahm-Kähler, P., Eklind, S., & Brännström, M. (2014). The future of human uterus transplantation. Women’s Health, 10(4), 455-467. Available online at:

https://journals.sagepub.com/doi/full/10.2217/WHE.14.22

(3) Robertson, J. A. (2016). Other women’s wombs: uterus transplants and gestational surrogacy. Journal of Law and the Biosciences, 3(1), 68-86. Available online at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033439/

(4) Johannesson, L., & Järvholm, S. (2016). Uterus transplantation: current progress and future prospects. International journal of women’s health, 8, 43. Available online at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751897/

(5) Mabiala, E., Kamińska, O., Szczepanowska, M., Kacperczyk, J., Dobrowolska-Redo, A., Bieniasz, M., … & Romejko-Wolniewicz, E. UTERUS TRANSPLANTATION AS A NEW METHOD IN UTERINE–FACTOR INFERTILITY (UFI). Uterus transplantation as a new method in uterine–factor infertility (UFI), 8. Available online at:

https://medtube.net/science/wp-content/uploads/2017/07/MEDtube-Science_2017-nr-02_v07_art1.pdf

(6) Zaami, S., Marinelli, E., di Luca, N. M., Vergallo, G. M., Refolo, P., Sacchini, D., … & Mozygemba, K. (2017). Ethical and medico-legal remarks on uterus transplantation: may it solve uterine factor infertility?. Eur Rev Med Pharmacol Sci, 21(22), 5290-6. Available online at:

https://www.europeanreview.org/wp/wp-content/uploads/5290-5296-Ethical-and-medico-legal-remarks-on-uterus-transplantation-may-it-solve-uterine-factor-infertility.pdf

(7) Brännström, M. (2017). Uterus transplantation and beyond. Journal of Materials Science: Materials in Medicine, 28(5), 70. Available online at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371630/

(8) Akar, M. E. (2015). Might uterus transplantation be an option for uterine factor infertility?. Available online at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358312/

Robert Velasquez
13 October, 2018

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Hello everyone, my name is Robert Velazquez. I am a content marketer currently focused on the medical supply industry. I studied Medicine for 5 years. I have interacted with many patients and learned a lot...read more:

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